Medical Science 2321–7367

ANALYSISANALYSIS ARTICLE 23(96), March - April, 2019

ISSN 2321–7359 EISSN Medical Science 2321–7367

The effect of Rhubarb stem extract on blood pressure and weight of type 2 diabetic patients

Fahimeh Shojaei-Shad1, Maryam Jahantigh-Haghighi2, Ali Mansouri2, Mahdieh Jahantigh-Haghighi3

Background and aim: Diabetes is a serious chronic disease that can damage the heart, blood vessels, eyes, kidneys and nerves, leading to death and early disability. Blood glucose control can prevent these complications. Also, a decrease in systolic blood pressure reduces the risk of each complication of diabetes and the risk of death from diabetes. Rhubarb is prescribed in traditional medicine for various patients, including patients with diabetes, high blood lipids and high blood pressure. However, its effect has not been scientifically reported. This study aimed to determine the efficacy of Rhubarb stem extract on hypertension and weight of type II diabetic patients. Methods: In this experimental study, 80 diabetic patients with type 2 diabetes mellitus in the city of Zabol, aged 30- 60 years old, fasting blood glucose greater than 140 mg /dl and hypertension above 140/90 mmHg, after matching they were randomly divided into two groups of 40 patients treated with Rivas stem capsules and placebo. Patients in both groups were evaluated for blood pressure and weight before and after the study. Results: The mean systolic blood pressure and diastolic blood pressure in the rhubarb group before and after the intervention were 144.87 ± 8.73 and 95.75 ± 7.72, respectively, after intervention, to 133.95 ± 10.98 and 83.73 ± 25.28% decrease. Paired t-test and Wilcoxon showed a significant decrease in systolic and diastolic blood pressure and diastolic blood pressure with rhubarb intervention (p <0.05), but no significant changes were observed in intervention and weight loss control groups (p <0.05). Conclusion: The use of 400 mg Rhubarb stem capsules three times a day in type 2 diabetic patients can significantly decrease systolic blood pressure and diastolic blood pressure, but there is a significant difference in weight loss between the two groups before and then the intervention did not work.

INTRODUCTION kidneys and nerves, leading to death and early disability (1). Diabetes Diabetes is a serious chronic illness, (1) with more than 220 million complications include skin lesions, hypertension and weight gain (9), people worldwide in 2010, the prevalence of diabetes in the world is and vascular complications of diabetes, including nerve fibrosis, 4.6%, which is between 3.8% and 2.10% of the closure Variable Nephropathy and retinopathy and macrovascular diseases, which are the geographic area (2). Type 2 diabetes is associated with tissue resistance leading cause of mortality in diabetic patients. Blood glucose, as well as to insulin and a relative lack of insulin secretion, although insulin is high blood pressure and high blood lipids, contribute to the risk of produced by beta cells in these patients, but this amount is not sufficient cardiovascular disease 9. High blood pressure is one of the risk factors to overcome insufficient resistance, resulting in increased blood glucose that, if not controlled, accelerate the progression of complications of (3). diabetes, especially cardiovascular problems. The UKPDS study showed The World Health Organization estimates that Type-2 diabetes will that any reduction in mmHg10 in systolic blood pressure causes a 12 rise from 171 million to 366 million in 2030. (4) Studies also show that percent reduction in the risk of each complication of diabetes and a 15 in 2025 more than 75% of the total population of diabetics in the country percent reduction in the risk of death from diabetes [10]. (5) 4 to 5 million people with diabetes live in Iran (6). The World Health The number of people with diabetes is rapidly increasing due to Organization (WHO) has reported it as an underlying epidemic (7), population growth, population aging, urbanization and industrialization, considering the increasing incidence of diabetes in the world. and an increase in the prevalence of obesity and physical inactivity (11). Diabetes mellitus is characterized by symptoms such as Type 2 diabetes is associated with an increase in mortality and a decline hyperglycemia, urination, fatigue, weight loss, delayed healing of the in quality of life. Therefore, it puts a lot of economic burden on health wounds, blurred vision, increased glucose in the urine, and some other systems and society (12). symptoms (8). The importance of this disease is due to the prevalence of To control diabetes, changes in lifestyle need to be made. Evidence its complications. Diabetes can damage the heart, blood vessels, eyes, suggests that if you have adequate blood glucose control, you can prevent or delay the long-term complications of diabetes (13). The 1Msc in Nursing, Zabol University of Medical Sciences, Zabol, Iran; 2Msc in

Nursing, Instructor, Faculty of Nursing and Midwifery, Zabol University of Medical primary treatment of type 2 diabetes is oral antidiabetic drugs (14). 159 3 Sciences, Zabol, Iran; Bsc in Nursing, Faculty of Nursing and Midwifery, Zahedan These drugs have disadvantages such as drug resistance development,

University of Medical Sciences, Zahedan, Iran; Page Corresponding Author: Maryam Jahantigh-Haghighi, Faculty of Nursing and side effects and even toxicity to response deficiencies. Moreover, none Midwifery, Zabol University of Medical Sciences, Zabol, Iran. of these glucose lowering drugs effectively control blood lipid levels.

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Table 1 Comparison of FBS, HBA1C, systolic and diastolic blood pressure mean in Rhubarb group and placebo group before and after intervention Rhubarb group Placebo group Group p-value p-value Before intervention After intervention Before intervention After intervention FBS 288/80±94/49 226/42±88/89 0/0001 252/55±82/98 252/72±85/33 0/94 HBA1C 9/62±1/58 7/83±1/50 0/0001 9/52±1/67 9/49±1/68 0/72 Systolic blood 144/78±8/73 133/50±10/98 0/0001 145/20±9/04 143/75±11/91 0/31 pressure diastolic blood 95/75±7/72 85/25±8/83 0/0001 95/37±8/72 93/37±7/95 0/19 pressure

Table 2 Comparison of the mean weight before and after taking Rhubarb and placebo Variable Before intervention After intervention T Df p-value

Mean of weight in Rhubarb group 74/97±10/98 75/83±12/89 1/43 21 0/15

Mean of weight in placebo 75/85±12/19 75/26±10/83 0/713 39 0/48

Therefore, with the increasing prevalence of diabetes and the adverse the patient by the therapist without any knowledge of it, and a special effects of synthetic drugs, there is a clear need for the development of code was inserted in the patient's file. Patients in the intervention group natural herbal resources for anti-diabetic drugs (9). received a can of 90 capsules of 400 mg (daily 3 am, noon, night) of the Rheum ribes is a plant that is known as the Polygonaceae family stem extract of the rhubarb plant and the placebo group was similarly (15), known as Rush, Rhubarb, or Rivend. Rhubarb root is used to treat delivered to a can of 90 mg placebo capsules. Patients in both groups diabetes, (15) and (16) hypertension, ulcers, obesity, diarrhea, and were evaluated for systolic and diastolic blood pressure and weight at sputum (17). Rhubarb has a laxative effect and is used to treat the end of the study after a month. constipation. Its root extract is also used to treat diabetes, stomach, liver, smallpox and rubella. Antioxidant properties and the presence of FINDINGS flavonoids in rhubarb, including quercetine, have been effective on The findings of this study showed that the mean age of subjects in the blood glucose and metabolic disorders in diabetes. (18). One of the most intervention group was 50.22 6.72 and in the control group (placebo) important properties of rhubarb is that it causes the pancreas to secrete 50.57 ± 6.60. The mean weight before the study in the intervention insulin and hence reduces blood glucose (19, 20). Rhubarb reduces lipid group was 74.97 ± 10.98 and 75.85 ± 12.19 in the control group. 27.5% and blood pressure (21) and, in combination with cinnamon, has an anti- of the participants in both control and intervention groups were male (n fatty and diabetes effect (22). Due to the increased prevalence of = 11) and 72.5% female (n = 29). Most of the research units were diabetes and cardiovascular and death problems, the result of this study illiterate in both control and control groups (65%) and intervention was to determine the efficacy of rhubarb stem extract on blood pressure (72.5%). There was no significant difference between the individuals in and weight in type 2 diabetic patients. the intervention and control groups in terms of demographic factors (p <0.05). Based on independent t-test and Mann-Whitney test between the METHOD two intervention and control groups in terms of systolic and diastolic This experimental study was performed on 80 patients with type 2 blood pressure and weight There was no significant difference (p <0.05). diabetes mellitus in Zabol city. Subjects were randomly divided into two The mean of systolic blood pressure in the intervention group groups of 40 patients receiving rhubarb and placebo extract. The criteria (rhubarb) before and after the intervention was 144.87 ± 8.73 and after for entering the study include ages 35-60 years, type 2 diabetes for at intervention was 133.50 ± 10.98. Based on Wilcoxon's statistical test, least 6 months, fasting blood glucose greater than 140 mg/dl for at least this reduction in cytological blood pressure after rhubarb intervention 0> two trials, systolic blood pressure above 140 mmHg and pressure p was meaningful. Diastolic blood pressure greater than 90 mm Hg, speaking ability, ability The mean of systolic blood pressure in the control group (placebo) to move and do activity, and not having late-onset diabetes was 45.15 ± 9.04 before placebo, which was 143.71 ± 11.91 after complications such as cardiovascular disease, foot ulcer, eye problems placebo. There was no significant difference between systolic blood According to physician, lack of Alzheimer's disease or mental illness pressure before and after placebo based on Wilcoxon test (p = 0.31). and Psychiatric, non-pregnancy or lactation was the absence of any The mean diastolic blood pressure in the intervention group autoimmune disorder (6.23). Exit criteria included severe physical (rhubarb) before and after the intervention was 95.75 ± 7.72 and 88.25 ± illness, drug discontinuation in diabetes control, oral glucose lowering 8.73 after intervention, which according to Wilcoxon statistical test, this drugs to insulin therapy, reluctance to use capsules, unwillingness to decrease in diastolic blood pressure after rhubarb intervention 0> p was participate in research, use of cigarettes, alcohol and drugs. After meaningful. explaining the purpose of the study for patients and obtaining written The mean diastolic blood pressure in the control group (placebo) informed consent, a general information questionnaire including before the placebo was 95.37 ± 8.72, which was 93.37 ± 7.95 after

demographic information (24) and information about the disease were placebo. Based on the Wilcoxon test, there was no significant difference completed by interviewing each patient. Then, for both groups, blood between diastolic blood pressure before and after placebo (p = 0.19). pressure measurements Systolic and diastolic and weight. All patients The mean of weight before intervention in the rhubarb and placebo

160 were urged to continue their blood glucose-lowering drugs without any group was 74.97 ± 10.98 and 75.85 ± 12.19, which was 73.35 ± 12.82 changes. The 90-gauge package of drug and placebo capsules was and 83.75 after intervention in the intervention group, respectively. / 10 Page similar in appearance and was given by a special code and delivered to ± 26/75. There was no significant difference between the mean of

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Figure 1 Mean of variables in intervention group 350

300

250

200

150

100

0 FBS HBA1C SBP DBP

Before After

weight before and after intervention in both groups of rhubarb and liver enzymes SGOT, SGPT and creatinine, indicating the health and placebo (p> 0.05); (Table 2), (Figure 1). safety of rhubarb (27). The study by Baha'addini, titled "The Effect of Rhubarb Flower on the Blood and Alcoholic Extract of Rhubarb Flower DISCUSSION on Blood Pressure in Male Rats," also showed a decrease in mean The results of this study indicate that the mean systolic and diastolic arterial pressure, systolic and diastolic pressure, and a significant blood pressure in the control group (placebo) before the placebo was decrease in heart rate in the intervention group compared with the 45.15 ± 9.04 and 95.37 ± 8.72, respectively, which was 91 / 143.75 ± 11 control. We are glad to use the Rhubarb flower in the study of and 93.37 ± 9.99, respectively. Based on the Wilcoxon test, there was no Bharwand, but in the present study, Rhubarb stem has been used. In his significant difference in systolic and diastolic blood pressure after study, Baharvand states that after acetylcholine injection in both control placebo (p = 0.31). The mean of systolic blood pressure in the rhubarb and rhythm tests, heart rate decreased, but in the experimental group it group before and after the intervention was 144.87 ± 8.73 and after the decreased more than the control group, as a result of the effect of intervention was 133.50 ± 10.98. Based on Wilcoxon statistical test, this decreased blood pressure on the possible rat. It can be rhubarb through decrease in cytological blood pressure after rhubarb intervention was> p the chronotropic effect of the heart (28). Hypertension is also rapidly was meaningful. The mean diastolic blood pressure in the rhubarb group associated with the accumulation of plaque atherosclerosis in the arterial before and after the intervention was 95.75 ± 7.72 and 88.25 ± 8.73 after wall (26). Therefore, the effects of rhubarb hypertension can be intervention, which according to the Wilcoxon statistical test, this attributed to the antioxidant, triglyceride and cholesterol (18, 27) effects. decrease in diastolic blood pressure after rhubarb intervention with p <0.05 Was meaningful. The mean of weight before intervention in the CONCLUSION rhubarb and placebo group was 74.97 ± 10.98 and 75.85 ± 12.19, which Since blood glucose control can prevent serious complications of was 73.35 ± 12.82 and 83.75 after intervention in the intervention group, diabetes, as well as a decrease in blood pressure, it reduces the risk of respectively. / 10 ± 26/75. There was no significant difference between any complication of diabetes and the risk of death from diabetes. the mean of weight before and after intervention in both groups of Therefore, the current study, considering the effects of Rhubarb stem on rhubarb and placebo (p> 0.05). the reduction of weight and blood pressure in diabetic patients, it is Considering the above findings, consumption of oral capsules of suggested that plant herbal remedies, especially rhubarb, should be rhubarb stem can significantly decrease blood pressure in type 2 diabetic considered in the treatment schedule of these patients, and extensive patients. The study of Baharond Ahmadi (2016), used as herbal remedy research into the effects of this herb in diabetic type 2 patients should be for cardiovascular disorders, also shows the effects of rheumatoid considered. arthritis (26), which is consistent with our study. Baharvand also states that antioxidant activity is one of the most important biological effects REFERENCES of medicinal plants, and this effect is mainly related to the presence of 1. World Health Orgenization. Global report on diabetes. 2016.

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